A 34-year-old woman without underlying disease presented to orthopedic clinic with a 2-month history of aggravated left thigh pain. The patient denied experiencing any other constitutional symptoms and no history of trauma or surgery during the past years. Physical examination showed tenderness on the left proximal thigh was positive and local skin temperature was slightly higher. Magnetic resonance imaging of spine revealed multiple bone destruction of left iliac bone, acetabulum, femoral head, femoral neck and upper femur, with high suspicion of bone metastases. Computed tomographic (CT) scan of chest revealed tiny, diffuse, miliary metastases in lungs (Figure 1). The bone scanning and ¹⁸F-fluorodeoxyglucose positron emission tomography/CT scan revealed multiple hypermetabolic foci in both lungs and multiple bones, which were highly suggestive of metastases of malignancy. After detailed analysis, we performed tissue biopsy of space occupying lesions in the right femur, and the pathology results confirmed poorly differentiated adenocarcinoma of lung. The biopsy specimen of the lung was consistent with the previous diagnosis with epidermal growth factor receptor (EGFR) mutation. The patient refused further treatment and died 1 year later.

中文翻译：

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肺癌中的粟粒状转移。

一名34岁无基础疾病的妇女就诊于骨科诊所，有两个月的左大腿疼痛加重病史。该患者否认在过去几年中经历过任何其他体质症状，也没有外伤或手术史。体格检查显示左大腿近端压痛为阳性，局部皮肤温度略高。脊柱的磁共振成像显示左骨，髋臼，股骨头，股骨颈和股骨多处骨质破坏，怀疑骨转移。计算机胸部断层扫描（CT）扫描显示，肺部发生微小，弥漫性粟粒状转移（图1）。骨扫描和¹⁸F-氟代脱氧葡萄糖正电子发射断层扫描/ CT扫描显示，在肺和多条骨骼中都有多个高代谢灶，这高度提示恶性转移。经过详细的分析，我们对右股骨进行了占位性病变的组织活检，病理结果证实了肺腺癌的分化较差。肺活检标本与先前对表皮生长因子受体（EGFR）突变的诊断一致。该患者拒绝进一步治疗，并于一年后死亡。